title: Review of Gardasil.
abstract: Human papillomavirus (HPV) is necessary for the development of cervical cancer. Cervical cancer is the second most common cancer in women worldwide but 80% occurs in developing countries, not countries with Pap screening programs. Pap screening programs in industrialized countries have reduced the incidence of cervical cancer to 4-8/100,000 women. HPV vaccines may be a promising strategy for cervical cancer in women without access to screening programs. In industrialized countries, the benefit of HPV vaccines focuses on individual abnormal Pap test reduction not cancer prevention. The focus of this review is to cover the side effects of Gardasil in perspective with the limited population benefit cervical cancer reduction in countries with organized Pap screening programs. In addition, information about Gardasil benefits, risks and unknowns for individual patient decision making for vaccination is presented. Gardasil offers protection against CIN 2+ lesions caused by HPV 16/18 and against genital warts caused by HPV 6/11 for at least 5 years. Combining Gardasil with repeated cytology screenings may reduce the proportion of abnormal cytology screens and hence reduce the associated morbidity with the subsequent colposcopies and excisional procedures.
authors.affiliation: Professor of Medicine, Director, Center of Excellence in Women's Health, University of Missouri-Kansas City School of Medicine, Departments of Biomedical and Health Informatics, Obstetrics and Gynecology and Community and Family Medicine.
authors.forename: Diane M
authors.initials: DM
authors.lastname: Harper
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Vierthaler
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Santee
keywords: Adverse effects; Cervical cancer; Duration of efficacy; Gardasil; HPV vaccine immunology